Dealing With Meal Plan Blahs

Have you ever felt blah about your diabetes meal plan? Eating healthfully for diabetes control demands time, thought, and emotion. People who are new to diabetes often have a lot to learn about planning healthy meals for blood glucose control, and figuring out a simple menu can start to feel like solving a complicated algebra problem. “Seasoned veterans,” while perhaps more knowledgeable about nutrition, can find it difficult to maintain the enthusiasm and energy needed to plan meals and snacks day after day after day. In either case, meal planning can begin to feel overwhelming, and healthful meals themselves can start to seem boring and unappetizing.

Short of chucking your meal plan and giving up altogether, is there any way to make the task of meal planning less burdensome? Can healthy meals be made more interesting? Can you have a treat now and then without disrupting your blood glucose control or feeling that you’re somehow doing something wrong? The answer, of course, is yes.

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Evaluating what you’ve got

To make any sort of change, it helps to first take stock of the current situation — in this case, your meal plan. Identify what you like and don’t like about it, how it suits your needs, and how it falls short.

If you were recently diagnosed with diabetes or never had the chance for a one-on-one meeting with a dietitian, it may be that you simply don’t know what to eat to keep your blood glucose level in control. This is a common problem. Another common problem is following your meal plan to the best of your ability, but finding you have out-of-range blood glucose monitoring results anyway. If either of these scenarios describes you, it’s a good idea to schedule a visit with a registered dietitian to get your questions answered and to get pointed in the right direction.

Even if you have an individualized meal plan, understand how to follow it, and generally have blood glucose readings in your desired range, you still may have the meal plan blahs. There may be ways in which your meal plan doesn’t suit your eating style or your likes and dislikes.

For example, are you a morning person, ravenous before you take your first step out of bed? If so, your idea of breakfast is likely to be quite different from that of a person who can’t imagine taking a bite of anything other than dry toast before 11:00 AM. But if your current meal plan only allows for a small bowl of cereal in the morning, it isn’t right for your eating style. Similarly, if your current meal plan includes a “treat” in the evening, but you’d rather have dessert with lunch, it doesn’t meet your needs, and you need a change. However, because changing the amount of carbohydrate you consume at any one meal or snack can affect your blood glucose, it’s best to consult your dietitian or primary health-care provider before making such a change. You may need to change other parts of your diabetes regimen, such as your medicine doses or schedule, to accommodate a change in meal plan.

What about food choices? A diabetes meal plan should provide adequate calories and nutrients, of course, but it should also include foods you like (and not those you don’t like). What’s more, it should include a way for you to have variety in your menus — not eat the same thing every day. Does yours?

And how about complexity? There are many ways to plan a healthy diabetes diet, and not all methods suit everyone. Some people tally up the exact number of grams of carbohydrate in a meal, in some cases so that they can match their insulin dose to their carbohydrate total. Others count “carbohydrate choices,” in which each choice contains 15 grams of carbohydrate. Some people use the Plate Method and pick a given number of servings from each food group for each meal. Some people use the Exchange Lists for Meal Planning, and their dietitian may have given them a meal plan that spells out the number of starch, meat, milk, fruit, fat, and vegetable exchanges to eat at each meal.

Choosing the method that works best for you depends in part on how you control your diabetes, but it also depends on your willingness and ability to use the method. Some people like a detailed meal plan that covers all the food groups; others would rather work around a carbohydrate goal for each meal and decide for themselves which foods (from which food groups) to eat. In many cases, people use a combination of methods to arrive at a meal-planning system that works for them. (See “Meal-Planning Resources” and “Tools for Meal Planning” for helpful resources.)

Sources of carbohydrate

Whatever meal-planning method you use, it’s important to gauge how much carbohydrate you eat. Foods containing carbohydrate directly affect your blood glucose level soon after you eat them. If you eat too little carbohydrate, you risk developing low blood glucose. If you eat too much carbohydrate at one sitting, your blood glucose level can skyrocket. For many people, eating about the same amount of carbohydrate at snacks and meals from one day to the next can aid in blood glucose control. People who use rapid- or short-acting insulin before meals may have more flexibility in the carbohydrate content of their meals since they can adjust their insulin dose according to the amount of carbohydrate they plan to eat. (This technique is best learned with the help of a diabetes professional.)

Determining how much carbohydrate to consume at each meal and snack is a matter of some trial and error. Dietitians typically recommend starting with about 4 carbohydrate choices (or 60 grams of carbohydrate) per meal at breakfast, lunch, and dinner. People who need more food might also have one or two snacks in their meal plan containing 1–2 carbohydrate choices (15–30 grams of carbohydrate) per snack. The amounts of carbohydrate in each meal can be fine-tuned based on blood glucose monitoring and personal preference.

Many foods contain carbohydrate, so learning which foods contain carbohydrate can be the first step toward adding more variety to your meal plan. The table “Carbohydrate Choices” lists some of the many options.

Starches and breads. Breads, cereals, dried beans, pasta, rice, potatoes, sweet potatoes, and winter squash are all sources of carbohydrate. One serving of each of these foods (as specified here) provides about 80 calories, 15 grams of carbohydrate, 3 grams of protein, and 0–1 grams of fat. Because they contain about the same amount of nutrients, a serving of one can be swapped for a serving of another without jeopardizing your blood glucose control. Therefore, if your meal plan calls for 1/3 cup of rice but you’re in the mood for something crunchy, you could have 3 cups of popped popcorn or 4–5 crackers instead. Similarly, if you’re eating on the run, you might choose a piece of toast over a half-cup serving of hot cereal. As long as the amount of carbohydrate in a serving is the same, one food can be substituted for another.

Some starchy foods are good sources of fiber, a form of carbohydrate that isn’t absorbed by your body but performs some important functions nonetheless, one of which is preventing constipation. Most Americans are advised to consume 25–35 grams of fiber per day, but check with your doctor or dietitian for the amount of fiber that’s right for you. Since fiber doesn’t raise blood glucose level, the number of grams of fiber in a serving can be subtracted from the total grams of carbohydrate if there are more than 5 grams of fiber per serving.

Fruits. Portion sizes for fruit can vary a lot. For example, 2 tablespoons of raisins, 1/3–1/2 cup of fruit juice, and 1 cup of melon each contain approximately 15 grams of carbohydrate (and about 60 calories, 0 grams of protein, and 0 grams of fat). That’s something to keep in mind when choosing a fruit exchange for your meal or snack — do you want something that will fill you up, or just a little something sweet? For some people, eating a serving of fruit at each meal can help to satisfy a sweet tooth and make it easier to say no to higher-fat sweets such as ice cream or cookies.

Milk. Dairy products such as milk and yogurt provide your body with calcium, riboflavin, and protein, as well as carbohydrate. One serving of milk or yogurt provides about 12–15 grams of carbohydrate and 8 grams of protein. Calorie and fat content depends on whether you choose whole, reduced-fat, low-fat, or nonfat products. Low-fat or nonfat dairy products are generally better choices for adults and children over two, but if you eat higher-fat products, don’t forget to count the grams of carbohydrate just the same.

More carbohydrates. It’s no secret anymore that many people with diabetes include some sugar or sugar-sweetened foods in their meal plan without having their blood glucose level zoom sky-high. Their secret? Planning ahead and learning to swap carbohydrate choices. For example, rather than eating lunch, then deciding they want some ice cream, they plan to eat a half-cup serving of ice cream as one of their carbohydrate choices or exchanges for the meal. That way, they get their ice cream but don’t surpass their total carbohydrate goal for lunch. Of course, people who adjust their premeal insulin dose according to the carbohydrate content of a meal might choose to simply add the ice cream to the meal and take more insulin. This tactic can keep blood glucose levels in target range, but it can also lead to weight gain if used too frequently.

How often you substitute sweet items for breads, starches, milk, or fruit is a matter of personal preference. For most people, it’s a good idea to do it only occasionally, since sweets generally have few nutrients other than carbohydrate and sometimes fat. For children or very active people who burn a lot of calories, however, a sweet or snack such as potato chips might be included in their meal plan on a daily basis. Older people generally have lower calorie needs and, ironically, higher vitamin and mineral needs, so eating too many sweets can rob them of needed nutrients and make it harder to maintain a desirable weight.

Another problem with sweets and desserts is that one serving (containing 15 grams of carbohydrate) is often small and not very filling, so it’s tempting to have two or three servings rather than one. You can help quell that urge by including higher-fiber foods such as beans, lentils, or cooked vegetables in the meal preceding dessert or by adding a big green salad with low-fat dressing to your meal; salad greens tend to fill you up without affecting blood glucose levels.

Low-carbohydrate foods

Carbohydrate counting is what gets emphasized most in diabetes meal planning, but foods with little carbohydrate should be counted too — for weight control and heart health as well as for blood glucose control.

Nutrition experts often classify lower-carbohydrate foods into four different categories: vegetables, meats and meat substitutes, fats, and “free foods.” When eaten in moderation, these foods do not have a direct effect on blood glucose level. However, eating too many servings of some free foods can raise blood glucose level, and eating too much meat, meat substitutes, or fat can lead to unwanted weight gain, which can also affect blood glucose control. So portion size is important even for most low-carbohydrate foods.

Vegetables. There is so little carbohydrate or fat in nonstarchy vegetables, it would be hard to eat too much of them, and since they are generally good sources of fiber, vitamins, and minerals (particularly vitamins A and C, iron, folic acid, and magnesium), it’s usually a good idea to eat more. If your current menus leave you feeling a little hungry, or your plate often looks colorless, try adding a serving or two of raw, lightly steamed, or sautéed vegetables. (A serving of vegetables is 1 cup raw or 1/2 cup cooked.) When you start feeling bored with your old favorites, try something new, or experiment with different cooking methods and flavorings. Sometimes a drizzle of olive oil and squeeze of lemon or some sautéed garlic and red pepper flakes are all it takes to liven up an otherwise dull vegetable side dish.

When shopping for vegetables, look for produce that’s in season in your area; it will usually taste better and cost less than imported, out-of-season produce. Frozen vegetables are a good substitute for fresh since they are often frozen immediately after harvest, and low-sodium canned vegetables are an alternative as well. (For more shopping tips, click here.)

Meats and other protein foods. Unprocessed red meat, poultry, and fish contain virtually no carbohydrate. Some other protein sources, such as soybean-based meat substitutes, do, so read package labels to see whether these protein sources also need to be counted as carbohydrate choices. For a heart-healthy diet, select lean cuts of red meat and poultry and low-fat cheeses and meat substitutes, and practice portion control: Most people need no more than 3 ounces of cooked meat at a meal.

When it comes to fish, fatty fish may be as good a choice as leaner fish. Many national health organizations are now urging people to eat two to three servings of fish per week, particularly fish containing high levels of omega-3 fatty acids, such as albacore tuna, herring, lake trout, mackerel, salmon, and sardines. Omega-3 fatty acids are believed to lower the risk of cardiovascular disease. Portion control is still important, however, and a portion of fish is generally 3 to 4 ounces.

Fats. A little fat can go a long way toward enhancing flavor in your meals. Fat can also help to slow down carbohydrate absorption in the gut, so don’t try to cut all the fat out of your diet. Instead, enjoy the textures and tastes of fats in moderation. Choosing oils high in monounsaturated fats, such as olive oil and canola oil, is recommended to maintain or improve heart health.

Free foods. A food is considered “free” if it provides no more than 20 calories or no more than 5 grams of carbohydrate per serving. Some free foods, such as diet soft drinks, contain no calories or carbohydrate, so even large amounts will not affect blood glucose level. Others, such as mayonnaise, contain a lot of fat, so only a small portion of the food is considered “free.” Free foods that are high in sodium, such as dill pickles, should be eaten in moderation regardless of whether they contain any carbohydrate or fat. Using foods on the free foods list in the table “Low Carbohydrate Foods” can help you work more flavor into your meals, make your meals and snacks a little more filling, and provide your taste buds with more variety.

When stuff happens

In an ideal world, each person would consume only as many calories as he needed each day and would always have a selection of fresh, low-fat foods available. In real life, things don’t always work out so nicely, but an occasional splurge or meal that doesn’t quite fit into your meal plan doesn’t have to be the end of the world. As long as you usually stick to your meal plan, you should be able to meet your diabetes and general health goals.

High-fat meals. An occasional high-fat meal is almost inevitable. If you know it’s coming, you might plan for it by keeping your other meals for the day moderate in fat content (but don’t skimp on meals or you’re likely to overeat later). You can also keep portion control in mind at the meal and try to keep yours small.

Some people find that a high-fat meal such as pizza raises blood glucose level later in the day, and many people who use insulin have learned to compensate with larger doses of mealtime insulin. Before trying this, it’s important to establish that a given meal or amount of fat actually does raise blood glucose, and it’s advisable to work with your dietitian or doctor when changing insulin doses.

Fast food. In general, fast food is high in fat and sodium and low in vitamins and fiber, so it’s not recommended as a diet staple. However, sometimes it may be all you’ve got. When that’s the case, you can still limit the damage by ordering smaller (not super-size) items and going easy on condiments and side dishes. If you must eat at fast-food restaurants regularly, ask for a copy of the restaurant’s nutrition information, and choose menu items that fit your meal plan as closely as possible.

Unplanned carbohydrate. Maybe you ate it by accident or maybe you couldn’t resist a treat you hadn’t planned for. Whatever the case, now your blood glucose is high. What do you do? Most of the time, all you can do is learn from the experience and try not to repeat it in the future. Your doctor or dietitian may have other suggestions for handling this situation.

Making meal planning manageable

Learning to add color, variety, and flavor to your meals definitely takes some work, but it’s worth it if it makes it easier to control your diabetes and enjoy your meals. Here are some tips for keeping meals interesting and meal-planning manageable:

Plan meals and read recipes when you have some free time and are not hungry.

Have some old standbys — that is, menus you like and have already analyzed for nutrient content — ready for when you’re in a rush or low on energy.

Keep your kitchen stocked with shelf-stable basics and a variety of condiments and flavorings so you can put meals together quickly.

Make sure you have an accurate set of measuring cups and spoons, and use them to measure portions.

Keep your meal plan and any reference tools you use handy (perhaps posted on the refrigerator) so you can determine the size of a serving in a jiffy.

Buy a new cookbook from time to time. There are many cookbooks written specifically for people with diabetes that have a nutrient analysis for each recipe, saving you from doing a lot of arithmetic to figure out how many grams of carbohydrate or other nutrients are in a serving.

If it’s the planning you dislike the most, shop around for a cookbook written for people with diabetes that suggests complete menus, not just individual recipes. Make sure the one you choose provides the calorie, carbohydrate, protein, fat, and sodium totals for the entire menu.

For positive reinforcement, check your blood glucose level about two hours after the start of a meal, particularly if measuring out portions or limiting the size of your food servings sounds restrictive. You should be pleasantly surprised by blood glucose measurements in the range determined by you and your health-care provider. Many people are also able to lose some weight by sticking to moderate portion sizes.

There’s no underestimating the importance of diet in diabetes control, but following a diabetes meal plan doesn’t have to limit your food choices. As long as you practice portion control and understand how to exchange one food for another, you can have all the variety you want.

Kelly Van Horn is a Nutrition Consultant and Certified Diabetes Educator for Swedish Diabetes Education Center, in Seattle, Washington. She is also the Research Dietitian for the Trial to Reduce IDDM in the Genetically at Risk (TRIGR) study at the University of Washington in Seattle. For TRIGR study information, go to www.trigr.org.

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